Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older
Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older
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DOI：
10.1159/000367853
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发表时间：
2015-01-01
影响因子：
1.6
通讯作者：
Madersbacher, Stephan
中科院分区：
文献类型：
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作者：
Berger, Ingrid;Wehrberger, Clemens;Madersbacher, Stephan
目的：降低老年人根治性膀胱切除术（RC）高并发症发生率的一个潜在策略是避免使用肠道进行尿流改道。本研究的目的是通过针对年龄 >= 75 岁患者的多中心研究来解决这个问题。患者和方法：我们对 2006 年至 2010 年间因肌层浸润性膀胱癌接受 RC 治疗的一系列年龄 >= 75 岁的患者进行了一项回顾性、多中心研究。根据改良的 Clavien-Dindo 分类对内科、手术和伤口并发症进行分级。结果：总共分析了 256 名患者（68% 为男性，平均年龄 79.6 岁）。 204 名 (80%) 名患者接受了肠道尿流改道术，52 名 (20%) 名患者接受了输尿管皮肤造口术 (UC)。 UC 患者年龄较大（82.0 岁 vs. 78.9 岁，p < 0.001），ASA 评分较高（2.6 vs. 2.3，p = 0.007），而平均 Charlson 评分较低（4.2 vs. 5.6，p < 0.001）。 UC 患者的手术时间较短（279 分钟 vs. 311 分钟，p = 0.002），并且在重症监护室的停留时间较短（0.9 天 vs. 2.2 天）。与接受肠道尿流改道的患者 (25.0%) 相比，UC 组中 Clavien III-V 级严重并发症的总体发生率 (11.5%) 显着较低 (p = 0.003)。 UC 组中严重（Clavien III-V 级）内科并发症（3.9% vs. 10.3%）和手术并发症（2.1% vs. 14.1%）的发生率均较低。 UC 组的住院患者 30 天和 90 天死亡率分别为 5.8%、7.7% 和 17.3%，而肠道组的死亡率分别为 3.9%、5.9% 和 6.9%。结论：RC 后的 UC 与老年患者较低的并发症发生率相关。需要膀胱切除术的老年、多病患者群体的不断增加可能证明重新考虑这种形式的转移是合理的。 (C) 2015 S. Karger AG，巴塞尔
Objective: A potential strategy to decrease the high complication rate of radical cystectomy (RC) in the elderly is to avoid the use of bowel for urinary diversion. The aim of this study was to address this issue in a multicentre study of patients aged >= 75 years. Patients and Methods: We performed a retrospective, multicentre study of a consecutive series of patients aged >= 75 years who underwent RC for muscle-invasive bladder cancer between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification. Results: A total of 256 patients (68% men, mean age 79.6 years) were analysed. 204 (80%) patients received a urinary diversion with use of bowel and 52 (20%) a ureterocutaneostomy (UC). Patients with UC were older (82.0 vs. 78.9 years, p < 0.001) and had a higher ASA score (2.6 vs. 2.3, p = 0.007), while the mean Charlson score was lower (4.2 vs. 5.6, p < 0.001). Patients with UC had a shorter operating time (279 vs. 311 min, p = 0.002) and a shorter period in the intensive care unit (0.9 vs. 2.2 days). The overall rate of severe complications graded as Clavien III-V was significantly lower in the UC group (11.5%) as compared to patients receiving bowel for urinary diversion (25.0%) (p = 0.003). Severe (Clavien grade III-V) medical (3.9 vs. 10.3%) and surgical (2.1 vs. 14.1%) complications were all less frequent in the UC group. Inpatient, 30- and 90-day mortality was 5.8, 7.7 and 17.3% in the UC group as compared to 3.9, 5.9 and 6.9% in the bowel cohort, respectively. Conclusion: UC following RC is associated with a lower complication rate in geriatric patients. The constantly increasing cohort of geriatric, multimorbid patients requiring cystectonny might justify reconsideration of this form of diversion. (C) 2015 S. Karger AG, Basel